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Am. J. Respir. Crit. Care Med., Volume 164, Number 4, August 2001, 585-589

Relationship between Extent of Pulmonary Emphysema by High-resolution Computed Tomography and Lung Elastic Recoil in Patients with Chronic Obstructive Pulmonary Disease

SIMONETTA BALDI, MASSIMO MINIATI, CALOGERO RICCARDO BELLINA, LUIGI BATTOLLA, GIOSUÉ CATAPANO, ENRICO BEGLIOMINI, DAVIDE GIUSTINI, and CARLO GIUNTINI

Istituto di Fisiologia Clinica del CNR, Centro Regionale di Medicina Nucleare, Istituto di Radiologia, Dipartimento Cardio Toracico, Università degli Studi di Pisa, Pisa, Italy

We investigated the relationship between the extent of pulmonary emphysema, assessed by quantitative high-resolution computed tomography (HRCT), and lung mechanics in 24 patients with chronic obstructive pulmonary disease (COPD). The extent of emphysema was quantified as the relative lung area with CT numbers < -950 Hounsfield Units (HU). Patients with COPD had severe airflow obstruction (FEV1 35 ± 15% pred) and severe reduction of CO diffusion constant (DCO/VA 37 ± 19% pred). Maximal static elastic recoil pressure (Pstmax) averaged 54 ± 24% predicted, and the exponential constant K of pressure-volume curves was 258 ± 116% predicted. Relative lung area with CT numbers < -950 HU averaged 21 ± 11% (range 1 to 38%). It showed a highly significant negative correlation with DCO/VA (r = -0.84, p < 0.0001), a weak correlation with FEV1% predicted, and no correlation with either Pstmax or constant K. A significant relationship was found between the natural logarithm of K and the full width at half maximum of the frequency distribution of CT numbers, taken as an index of the heterogeneity of lung density (r = 0.68, p < 0.0005). We conclude that currently used methods of assessing the extent of emphysema by HRCT closely reflect the reduction of CO diffusion constant, but cannot predict the elastic properties of the lung tissue.

Keywords: Pressure-volume curve; elastic recoil pressure; HRCT quantitative analysis; emphysema heterogeneity




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